Limits...
Multilevel Correlates of Non-Adherence in Kidney Transplant Patients Benefitting from Full Cost Coverage for Immunosuppressives: A Cross-Sectional Study.

Marsicano EO, Fernandes NS, Colugnati FA, Fernandes NM, De Geest S, Sanders-Pinheiro H - PLoS ONE (2015)

Bottom Line: Higher family income was the only factor that was associated with immunosuppressive non-adherence.In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation.This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

View Article: PubMed Central - PubMed

Affiliation: Renal Transplantation Unit, Division of Nephrology, School Hospital of Federal University of Juiz de Fora, Minas Gerais, Brazil.

ABSTRACT

Background: Adherence is the result of the interaction of the macro, meso, micro, and patient level factors. The macro level includes full coverage of immunosuppressive medications as is the case in Brazil. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system.

Methods: Using a cross-sectional design, adherence to immunosuppressives was assessed in a sample of 100 kidney transplant patients using a composite non-adherence score consisting of three methods (self-report [i.e., The Basel Adherence Scale for Assessment of Immunossupressives-BAASIS], collateral report, and immunosuppressive blood levels). Multilevel correlations of non-adherence were assessed (macro, meso, micro and patient level). Univariate and multivariate logistic regression was applied to assess the correlates of non-adherence.

Results: Our sample consisted primarily of male (65%), Caucasians (72%) with a mean age of 45.0 ± 13.5 years old, who received grafts from a living donor (89%), with a mean time after transplantation of 72.3 ± 44.4 months. Prevalence of non-adherence was 51%. Family income higher than five reference wages (21.6 vs. 4%; OR 6.46 [1.35-30.89], p = 0.009; patient level), and having access to private health insurance (35.3% vs. 18.4%; OR 2.42 [0.96-6.10], p = 0.04; meso level) were associated with non-adherence in univariate analysis. Only the higher family income variable was retained in the multiple logistic regression model (OR 5.0; IC: 1.01-25.14; p = 0.04).

Conclusions: Higher family income was the only factor that was associated with immunosuppressive non-adherence. In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation. This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

Show MeSH

Related in: MedlinePlus

Data collection process involving the screening and determination of eligibility of study participants according to the inclusion criteria.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4664247&req=5

pone.0138869.g001: Data collection process involving the screening and determination of eligibility of study participants according to the inclusion criteria.

Mentions: All patients attending routine visits between 1 May to 1 December 2010, who fulfilled the study inclusion criteria and did not have the exclusion criterion, were invited to participate in the study. They received written and oral information before signing the written informed consent form. Trained nurse interviewers who were part of transplantation team administered the BAASIS. Both the renal nurse and the physician treating the patient filled out the collateral report form. The blood assay was collected from the medical files. Correlates were assessed by interviewers or were collected from the medical files (Fig 1).


Multilevel Correlates of Non-Adherence in Kidney Transplant Patients Benefitting from Full Cost Coverage for Immunosuppressives: A Cross-Sectional Study.

Marsicano EO, Fernandes NS, Colugnati FA, Fernandes NM, De Geest S, Sanders-Pinheiro H - PLoS ONE (2015)

Data collection process involving the screening and determination of eligibility of study participants according to the inclusion criteria.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664247&req=5

pone.0138869.g001: Data collection process involving the screening and determination of eligibility of study participants according to the inclusion criteria.
Mentions: All patients attending routine visits between 1 May to 1 December 2010, who fulfilled the study inclusion criteria and did not have the exclusion criterion, were invited to participate in the study. They received written and oral information before signing the written informed consent form. Trained nurse interviewers who were part of transplantation team administered the BAASIS. Both the renal nurse and the physician treating the patient filled out the collateral report form. The blood assay was collected from the medical files. Correlates were assessed by interviewers or were collected from the medical files (Fig 1).

Bottom Line: Higher family income was the only factor that was associated with immunosuppressive non-adherence.In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation.This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

View Article: PubMed Central - PubMed

Affiliation: Renal Transplantation Unit, Division of Nephrology, School Hospital of Federal University of Juiz de Fora, Minas Gerais, Brazil.

ABSTRACT

Background: Adherence is the result of the interaction of the macro, meso, micro, and patient level factors. The macro level includes full coverage of immunosuppressive medications as is the case in Brazil. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system.

Methods: Using a cross-sectional design, adherence to immunosuppressives was assessed in a sample of 100 kidney transplant patients using a composite non-adherence score consisting of three methods (self-report [i.e., The Basel Adherence Scale for Assessment of Immunossupressives-BAASIS], collateral report, and immunosuppressive blood levels). Multilevel correlations of non-adherence were assessed (macro, meso, micro and patient level). Univariate and multivariate logistic regression was applied to assess the correlates of non-adherence.

Results: Our sample consisted primarily of male (65%), Caucasians (72%) with a mean age of 45.0 ± 13.5 years old, who received grafts from a living donor (89%), with a mean time after transplantation of 72.3 ± 44.4 months. Prevalence of non-adherence was 51%. Family income higher than five reference wages (21.6 vs. 4%; OR 6.46 [1.35-30.89], p = 0.009; patient level), and having access to private health insurance (35.3% vs. 18.4%; OR 2.42 [0.96-6.10], p = 0.04; meso level) were associated with non-adherence in univariate analysis. Only the higher family income variable was retained in the multiple logistic regression model (OR 5.0; IC: 1.01-25.14; p = 0.04).

Conclusions: Higher family income was the only factor that was associated with immunosuppressive non-adherence. In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation. This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

Show MeSH
Related in: MedlinePlus